Primary and secondary histiocytic lymphoma of the brain: CT features

The authors examined 19 patients with diffuse histiocytic lymphoma of the brain, including 8 with primary disease and 11 with secondary disease. Both primary disease and secondary disease involving the brainstem and deep nuclei exhibited the characteristic CT appearance, consisting of a large, solid, homogeneously enhanced mass with varying amounts of edema. However, most secondary lymphomas outside the brainstem and basal ganglia contained large areas of low attenuation consistent with necrosis. Multifocal lesions were seen only in patients with secondary lymphoma. Systemic chemotherapy for extracranial lymphoma had no effect on the CT appearance of intracranial lesions. The authors suggest that these "unusual" CT patterns are actually typical of a distinct subset of histiocytic lymphomas.     

Value of chest radiography in excluding traumatic aortic rupture

A retrospective review of chest radiographs from 205 patients with blunt chest trauma who also underwent aortography was performed. Forty-one of the 205 had aortographically proved aortic rupture. Discriminant analysis of 16 radiographic signs indicated that the most discriminating signs were loss of the aorticopulmonary window, abnormality of the aortic arch, rightward tracheal shift, and widening of the left paraspinal line without associated fracture. No single or combination of radiographic signs demonstrated sufficient sensitivity to indicate all cases of traumatic aortic rupture on plain chest radiographs without the performance of a large number of aortographically negative studies. The bedside anteroposterior "erect" view of the chest proved far more valuable than the supine view in detecting true-negative studies. Despite significant reader variability in the interpretation of the various radiographic signs, in general the analysis confirmed the role of chest radiography in this clinical situation, but suggests that its most beneficial use is in excluding the diagnosis and eliminating unwarranted aortography rather than in predicting aortic rupture.     

Quality of life in children with congenital heart defects

Quality of life was measured in children with congenital heart defects (CHDs) registered in a total population of infants born live in the period 1982–91 ( n = 22 810), using essential life spheres: external living conditions, interpersonal and personal conditions. In 200 children with CHD alive at the time the investigation was performed, 164 (82%) of the families answered a questionnaire addressing different dimensions of these quality of life spheres. Three subgroups of CHDs were investigated: CHDs spontaneously cured ( n = 80), CHDs treated by surgery ( n = 56), and CHDs with associated syndromes/ malformations ( n = 29). 301 (75%) out of 400 controls, matched for age and habitat (county), answered the same questionnaire. The children's ages at investigation were 2y 2 months-12y 2 months (median 6y 1 month). There were no statistically significant differences between the CHD groups and the controls for overall quality of life for any of the three life spheres ( p > 0. 05). In children with operated CHDs and CHDs associated with syndromes/malformations, quality of life was influenced at some aspects of the external as well as at the interpersonal and personal levels. A trend existed for a higher subjective experience of quality of life in the total CHD group as well as in all the subgroups. It is speculated that this may represent development of coping mechanisms and recalibration of values of life.     

Bone marrow transplantation for mucopolysaccharidosis type I: experience of two British centres

Bone marrow transplantation was carried out on 38 patients with mucopolysaccharidosis type I over a period of 15 years. The donor was an HLA identical relative in 10 cases, an HLA non-identical relative in 16 cases, and an HLA identical unrelated volunteer donor in 12 cases. Ten patients received a second transplant. One patient received three transplants. Thirteen engrafted patients have survived five years or more. Most patients have shown an arrest or slowing down of psychomotor regression. However, dysostosis multiplex has progressed. Careful selection of patients may be necessary to ensure optimum results.     

Abnormal technetium labelled white cell scan in the colitis of chronic granulomatous disease

A child with colitis was treated for Crohn's disease, diagnosed on history, clinical and colonoscopic findings, radiolabelled white cell bowel scan, and colonic histology. After septicaemia caused by an unusual organism, further investigation lead to a diagnosis of chronic granulomatous disease (CGD). The granulomatous colitis of CGD is clinically, histologically, and on white cell scanning, indistinguishable from that in Crohn's disease and should be considered in atypical cases. Infection with unusual 'pseudomonads' should prompt the exclusion of this disorder.     

Resistance to chemically-induced mammary tumors in Copenhagen X nude- derived F2 athymic rats: evidence that T-cell immunity is not involved in Copenhagen resistance

Resistance to chemically-induced mammary tumors in the Copenhagen rat is well defined, but the mechanism of resistance has yet to be determined. We have tested whether or not Copenhagen rat resistance is dependent on T-cells, since several lines of evidence supported an involvement of the immune system. We crossed Copenhagen rats with an athymic nude rat to produce F1s, that were interbred to produce F2 animals, some of which were athymic with partial Copenhagen rat background. A comparison of the mammary tumor incidences between the nude athymic F2 animals and their non-nude littermates allowed us to determine what role, if any, T-cells played in resistance. Following treatment with N-methyl-N-nitrosourea, we observed no difference in the tumor incidences between the two groups. Furthermore, the mammary tumor incidences in the F2 nude and non-nude animals was almost zero. These results indicate that T-cells are not involved in Cop resistance, and that nude rats are resistant to N-methyl-N-nitrosourea-induced mammary tumorigenesis.      

Designing criteria to handle diabetes patients as a strategy for quality assurance

This study was carried out at the General Hospital of Zone N masculine 14 of the IMSS in Jalisco, Mexico, with the goal of designing standardized criteria to handle hospitalized diabetes patients, as a strategy for quality assurance, through the participation of a panel of experts in internal medicine from the hospital. Participation by the attending physician in designing criteria generates a sense of belonging in the staff and makes adherence and application easier. The suggested criteria are subject to further improvement and are not intended for universal application, but to the extent that they have been useful in patient care they have far surpassed the authors' expectations when the goals of this research were originally established.     

Prenatal diagnosis of low level trisomy 15 mosaicism: review of the literature

Low level chromosome mosaicism found at amniocentesis is problematic for clinicians and patients. We report prenatal diagnosis of a fetus with a rare karyotype of 47.XX, + 15/46, XX. Second trimester amniocentesis was performed for advanced maternal age. Fetal ultrasound revealed a hypoplastic right ventricle and intrauterine growth retardation (IUGR). The rest of the fetal anatomy was within normal limits. A mosaic karyotype of 47.XX, + 15/46, XX was observed. The couple interrupted the pregnancy at 19 weeks by dilation and suction evacuation. Careful evaluation of multiple pieces of fetal parts and placenta revealed one abnormal finding: a single umbilical artery. Cytogenetic metaphase and fluorescent in situ hybridization (FISH) interphase analyses of cells from fetal lung, heart, placenta, and skin revealed the presence of the trisomic line in all tissues. Molecular analysis demonstrated that the origin of the extra chromosome 15 was maternal, the error most likely occurred in meiosis I and the diploid line was of biparental inheritance. This case report discusses the associated findings in this fetus and reviews the literature describing other cases of mosaic trisomy 15.